[Congenital melanocytic nevi]

[Therapy of congenital melanocytic nevi. Excision, dermabrasion, laser]

Congenital melanocytic nevi are rare lesions which depending on their size and location may cause major cosmetic and psychological problems. Large congenital melanocytic nevi may undergo malignant change and can also be associated with neurocutaneous melanosis. The different treatment approaches reach different levels of the skin. Complete excision is the treatment of choice, but is not always possible with giant nevi. Superficial treatment can reduce the pigmentation, but repigmentation is not uncommon. Incomplete removal of melanocytic nevi does not reduce the melanoma risk. Surgical intervention must be carefully planned; the advantages and disadvantages of the different modalities must be discussed with the parents. The risk of malignant transformation must be weighed up against the expected aesthetic and functional outcomes.

Comparative treatment of giant congenital melanocytic nevi with curettage or Er:YAG laser ablation alone versus with cultured epithelial autografts

BACKGROUND

Treatment options for congenital melanocytic nevi (CMN) include complete surgical excision, dermabrasion, curettage, and laser therapy. Fresh cultured epithelial autograft (CEA) after curettage or erbium:yttrium-aluminum-garnet (Er:YAG) ablation presents a novel option in the management of large-sized or giant CMN.

OBJECTIVE

The purpose of this study was to evaluate the outcome of CEA after curettage or Er:YAG ablation of CMN and to compare the safety, efficacy, and side-effect profile of CEA with the non-CEA group.

METHODS

Ten patients with CMN were treated with curettage (one patient), Er:YAG ablation (four patients), or both (five patients) followed by CEA, and eight patients were treated with curettage (two patients), Er:YAG ablation (one patient), or both (five patients) without CEA. All 18 patients were evaluated at week 16 after the operation with respect to pigmentation, erythema, hypertrophic scarring, textural change, granulation tissue formation, infection, and healing time. Global Assessment Scale scores were graded before and 16 weeks after the operation by physicians and patients.

RESULTS

Reduced pigmentation in the treated areas was seen in both groups, but the time to complete healing was significantly shorter in the CEA than in the non-CEA group (p < .05). There was less hypertrophic scar formation and granulation tissue formation and fewer other side effects in the CEA group.

CONCLUSION

In view of the favorable outcome of CEA combined with curettage or Er:YAG laser ablation in the treatment of giant CMN, CEA is a safe and effective novel treatment adjunct that accelerates healing, with fewer side effects.

[Neurocutaneous melanosis and malignant melanoma]

A 36-year-old man presented with a giant congenital melanocytic nevus and multiple disseminated melanocytic nevi. After he had developed neurological symptoms (grand mal seizures), a cerebral metastasis of a malignant melanoma without a primary melanoma was found. The patient was diagnosed as having a neurocutaneous melanosis with a cerebral metastasis. In spite of a variety of therapeutic attempts (surgery, radiation therapy and chemotherapy) he followed a rapidly progressive, lethal course with increased intracranial pressure, hydrocephalus and spinal metastases.

Multicentric malignant melanoma in a giant melanocytic congenital nevus 20 years after dermabrasion in adulthood

BACKGROUND

Dermabrasion is one approach to the treatment of treating giant melanocytic congenital nevi. Treatment is recommended to reduce the risk of spontaneous malignant transformation of giant nevi into malignant melanomas that usually occur in childhood.

OBJECTIVE

To describe the development of a multicentric malignant melanoma in a giant melanocytic congenital nevus after dermabrasion.

METHODS

We report about a 46-year-old male patient who developed a multicentric malignant melanoma in a giant melanocytic congenital nevus. The nevus was located on his left shoulder extending to his neck and chest. Previously, dermabrasion of the nevus was performed twice at the ages of 26 and 28.

RESULTS

To our knowledge, this is the first report of malignant transformation of a giant nevus into a multicentric malignant melanoma diagnosed 20 years after the procedure of dermabrasion.

CONCLUSION

We conclude that a close follow-up of such patients is mandatory.

Cerebriform giant melanocytic nevus of the scalp: report of two cases with different surgical approaches

Cerebriform giant melanocytic nevus of the scalp is an extremely rare malformation. Clinical appearance with maceration and fetor within the crypts and the risk of malignant transformation may require surgical therapy. We report two cases with different methods of surgical management. A 27-year-old woman noticed a swelling of the parietal scalp that developed over a period of 4 years into a gyrus-like tumor measuring 12 cm x 18 cm. The crypts between the gyri could not be inspected. Serial excisions under subcutaneous infusion anesthesia were performed to reduce the size of the nevus and to flatten the surface of the scalp. The second patient, a 26-year-old man, demonstrated a giant 10 cm x 10 cm cerebriform nevus on the occiput. The nevus also contained areas of fetid maceration. After implanting a tissue expander under general anesthesia the nevus was excised. The defect was closed using a rotation flap.

The use of digital dermoscopy for the follow-up of congenital nevi: a pilot study

One of the main problems in the management of congenital nevi is the potential risk for malignant transformation and the resulting need for follow-up examination. Dermoscopy is a noninvasive technique that has been shown to be useful for the follow-up of benign melanocytic skin lesions as well as the early diagnosis of malignant melanoma. Therefore we thought to use the digital dermoscopy (DD) technique for the follow-up of congenital nevi. For documentation purposes we registered an overview, and the following standardized dermoscopic images of every lesion: representative architectural pattern, border of the lesion, and regions of "special interest." In all instances the examination with digital dermoscopy was well tolerated by the patients and the integration of the parents to the "live" examination on the computer screen was appreciated. The follow-up was easy to perform with these standardized documents. We showed the feasibility of follow-up of congenital nevi using digital dermoscopy. Furthermore, we identified three different patterns as well as some typical structures seen in congenital nevi by DD.